Non-thyroid neck lumps: appraisal of the role of fine needle aspiration cytology.

To compare the non-diagnostic rate of fine needle aspiration cytology (FNAC) of non-thyroid neck lumps performed under ultrasound (US) guidance against non-guided FNAC (performed in outpatient clinic). Final histology results were compared with cytological diagnosis. We performed a retrospective study of 625 patients identified as having undergone FNAC of non-thyroid neck lumps from the pathology/radiology databases over a 3 year period. A total of 396 patients underwent non-ultrasound guided FNAC (12 excluded). 34% of patients had a non-diagnostic sample. A total number of 229 patients underwent ultrasound guided FNAC with a non-diagnostic rate of 12%. The Chi-squared test showed a significant difference (P < 0.001). FNAC results were compared with definitive histology in 238 patients. Sensitivity was 92% and specificity was 90%. US-guided FNAC resulted in a lower non-diagnostic rate. FNAC was highly sensitive for diagnosis of malignant lumps but less good at confirming a lump to be benign.

Measurement of health status in patients with vertigo.

In order to assess how much disability is caused by vertigo, health status scores of patients referred with dizziness or vertigo were compared with local population normative data and with the severity of illness, measured by a disease-specific questionnaire. The questionnaires were administered by post to patients awaiting an ENT out-patient appointment. There was a strong correlation (P = 0.001) between the eight dimensions of the SF-36 (Mos 36 item short-form health survey) and disease severity, measured by the Dizziness Handicap Inventory questionnaire. Compared with the general population, vertigo sufferers had significant role limitation due to physical problems and social functioning (men) and physical problems and vitality (women). General health status is significantly affected by both the presence and severity of vertigo and the SF-36 may prove useful in assessing outcomes.

Submental abscess: an unusual delayed complication of primary Blom-Singer valve insertion.

Voice restoration following laryngectomy can be achieved by the now well accepted technique of inserting a 'Blom-Singer' prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion include haemorrhage, oesophageal perforation, peristomal cellulitis and aspiration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being forced from the fistula up between the trachea and the pharynx, this plane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phonate. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.

A scale of attitudes toward the application of eugenics to the treatment of people with mental retardation.

As part of a larger study of the attitudes of diverse samples towards the application of eugenics to the treatment of people with mental retardation, a 32-item summated rating scale was developed as a contemporary, brief, easy to administer and score, and psychometrically sound instrument. Data were collected and analysed that indicated satisfactory item characteristics and reliability, and initial support for the content and construct validities of the scale. Analyses of social desirability data revealed that scale scores were not influenced by the subjects' desire to adhere to socially desirable expectations. The scale should be useful for the investigation of questions concerning the formation, structure and correlates of attitudes toward the application of eugenics to the treatment of people with mental retardation, and the relationship of these attitudes to contemporary mental retardation policies and practices.

The feeding pharyngostomy: an alternative approach to enteral feeding.

We present a six-year retrospective review of feeding pharyngostomies as performed in this department. The indications, technique and complications of this procedure are discussed.

Wound amylase estimation and the prediction of pharyngocutaneous fistulae.

Pharyngocutaneous fistula is a common complication after major head and neck surgery. In this study it was possible to predict fistula formation as early as the second postoperative day, using serial measurements of the amylase concentration in wound drainage. Wound amylase estimation may be used to help avoid major pharyngocutaneous fistulae by providing an 'early warning' and allowing modification of the postoperative feeding regimen in certain situations.

Effect of weather conditions on acute laryngotracheitis.

The aim of the study was to examine the incidence of croup in the Swansea area and to determine whether meteorological factors have any effect on the incidence of acute laryngotracheitis requiring hospitalization. 447 patients with a diagnosis of acute viral croup were admitted to the Ear, Nose and Throat Department of Singleton Hospital, Swansea, between January 1st 1980 and December 31st 1984. There was no significant difference between days with and without croup admissions, with respect to barometric pressure or relative humidity. Maximum and minimum temperatures were significantly lower on days with croup admissions (p less than 0.001). Wind direction appeared to influence the number of admissions, which were increased when the wind was from the south-east (p less than 0.01).

Prediction and prevention of fistulae after major head and neck surgery: a preliminary report.

A method of checking the integrity of mucosal repair after head and neck surgery using wound amylase levels is described. A low wound amylase concentration allows early resumption of oral intake; an increasing amylase concentration is a strong predictor of subsequent wound breakdown and fistula formation. A regimen has been developed which has prevented fistulae from developing in the small number of patients studied thus far.

Tympanoplasty surgery and prophylactic antibiotics: surgical results.

This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. A total of 130 individuals were randomly allocated to either an antibiotic or a non-antibiotic group. Each individual was clinically and audiometrically assessed preoperatively, and 8 weeks postoperatively. It was found that systemic prophylactic antibiotics did not influence either the success rate of myringoplasty surgery or the audiometric result.

Systemic antibiotic prophylaxis and reconstructive ear surgery.

This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.

Low-powered ultrasound in the inhibition of tinnitus.

An experiment was performed using low-level ultrasound in an attempt to inhibit tinnitus during and after stimulation. The method used a double-blind crossover technique with a placebo. Forty subjects were tested, and they generally reported little or no change in their tinnitus, the results from placebo and ultrasound not being statistically different. It cannot be concluded, therefore, that the ultrasound we were using has any beneficial effect on tinnitus. These results do not confirm the findings of the pilot study using the same ultrasound devices (Carrick et al., 1986).

Low-powered ultrasound in the treatment of tinnitus: a pilot study.

The aim of this study was to determine whether a low dose of ultrasound, applied over the mastoid bone, caused a subjective improvement in the level of tinnitus in long standing tinnitus sufferers. Forty patients from the Swansea Tinnitus Association volunteered to take part in a double blind crossover trial. They received a 10-minute treatment with an ultrasound generator and an identical placebo device on two separate visits. The devices were randomly allocated on the first visit. At each visit the patient noted whether their tinnitus was completely improved, slightly improved, unchanged or made worse by the treatment. Forty per cent of patients who completed the trial were improved by ultrasound, 7% by placebo. Low powered ultrasound was significantly better at producing improvement than placebo (P less than 0.02 Binomial Test).

The effect of adenoidectomy on nasal resistance to airflow.

The aim of the research was to determine whether the operation of adenoidectomy affected the nasal resistance to airflow. The total nasal respiratory resistance (TNR) was measured in forty-four children admitted for adenoidectomy and myringotomies, with or without tonsillectomy. The measurement was repeated three months post-operatively. There was significant correlation between the pre-operative TNR and the weight of adenoid removed at operation. A history of snoring pre-operatively, which was absent after operation, was related to a high pre-operative TNR and large adenoids. Those children in whom at least one gram of adenoid tissue was removed, were found to have a mean reduction in nasal resistance of 19%.